Older care-home residents as collaborators or advisors in research: a systematic review

Background: patient and public involvement (PPI) in research can enhance its relevance. Older care-home residents are often not involved in research processes even when studies are care-home focused. Objective: to conduct a systematic review to find out to what extent and how older care-home residents have been involved in research as collaborators or advisors. Methods: a systematic literature search of 12 databases, covering the period from 1990-September 2014 was conducted. A lateral search was also carried out. Standardised inclusion criteria were used and checked independently by two researchers. Results: 19 reports and papers were identified relating to 11 different studies. Care-home residents had been involved in the research process in multiple ways. Two key themes were identified: (i) the differences in residents’ involvement in small-scale and large-scale studies, (ii) the barriers to and facilitators of involvement. Conclusions: small-scale studies involved residents as collaborators in participatory action research, whereas larger studies involved residents as consultants in advisory roles. There are multiple facilitators of and barriers to involving residents as PPI members. The reporting of PPI varies. While it is difficult to evaluate the impact of involving care-home residents on the research outcomes, impact has been demonstrated from more inclusive research processes with care-home residents. The review shows that older care-home residents can be successfully involved in the research process

Orthoptic Services in the UK and Ireland During the COVID-19 Pandemic.

AimCOVID-19 has widely impacted hospital services. The purpose of this study was to determine the impact of COVID-19 on Orthoptists and their clinical practice in the UK, Ireland, and Channel Islands.MethodsWe conducted a prospective survey-based cross-sectional study using an online survey aiming for coverage of orthoptic departments across the UK, Ireland, and Channel Islands. We circulated the online survey through the British and Irish Orthoptic Society that reaches over 95% of UK and Irish orthoptic services, and through social media and orthoptic research networks.ResultsThe survey response rate was 79%. The survey was completed by orthoptic departments, on average 10 days post lockdown. Many orthoptic services were cancelled/paused with remaining services largely reserved for emergency cases and urgent care. A substantial rise in tele-consultations was reported by 94%, which largely consisted of telephone and video calls and which was regarded generally as working well. Barriers to tele-consultations were mainly IT related but with concerns also raised regarding ethical and confidentiality issues. Shortage of personal protective equipment (PPE) was reported by one third of departments along with issues relating to conflicting information about the use of PPE.ConclusionsWe have reported information on the changing face of orthoptic clinical practice during the COVID-19 pandemic. The survey has highlighted emerging tele-consultation practice and the importance of centralised profession-specific guidelines

Defining mechanisms of neurodegeneration associated with protein misfolding diseases

Protein misfolding diseases (PMDs) are a broad group of disorders including Alzheimer’s, Parkinson’s and prion diseases. They are characterised by the presence of aggregated, misfolded host proteins which are thought to cause cell death. Prion diseases are associated with misfolded prion protein (PrPSc), which has a tendency to form fibrillar aggregates. By contrast, Alzheimer’s disease (AD) is associated with misfolded amyloid beta (Aβ), which aggregates to form characteristic Aβ plaques. A feature which is common across PMDs is that small assemblies (oligomers) of the misfolded proteins are thought to be the important neurotoxic species, and it has been proposed that there may be a shared mechanism leading to cell death across PMDs caused by oligomers. In this study, the toxicity of different misfolded forms of recombinant PrP (recPrP) and recombinant Aβ (recAβ) and the mechanisms leading to cell death were investigated using a primary cell culture model. In addition, the importance of the disulphide bond in recPrP in relation to oligomer formation was explored using size exclusion chromatography and mass spectrometry, the toxicity of the different resulting oligomer populations were also investigated. Both recPrP oligomers and fibrils were shown to cause toxicity to mouse primary cortical neurons. Interestingly, oligomers were shown to cause apoptotic cell death, while the fibrils did not, suggesting the activation of different pathways. By contrast, recAβ fibrils were shown to be non-toxic to cortical neurons, Aβ oligomers, however, were shown to cause toxicity. Similar to recPrP, my data showed that it is likely that recAβ 1-42 oligomers also cause apoptosis. However, by contrast this seemed to be caused by excitotoxicity, which was not found to be the case for recPrP. Additionally, I have shown that the presence or absence of the disulphide bond in PrP has a profound effect on the size of oligomers which form. RecPrP lacking a disulphide bond leads to the formation of larger oligomers which are highly toxic to primary neurons. Findings from this study suggest that structural properties such as the disulphide bond in PrP can affect the size and toxicity of oligomers, furthermore, whilst oligomers have been shown to be important in both AD and prion diseases, they may not trigger the same pathways leading to cell death

Impact of a national professional development programme for out-of-field teachers of mathematics in Ireland.

Out-of-field teaching refers to the practice of assigning teachers to teach subjects that do not match their training or education. This paper reports on a study evaluating the impact of a national professional development programme for out-of-field teachers of post-primary school mathematics in Ireland – the Professional Diploma in Mathematics for Teaching. Evidence of impact was collected from three surveys. Two surveys evaluated changes in the prevalence of out-of-field teaching before and six years after the introduction of the programme. The third survey investigated programme graduates’ beliefs about mathematics, mathematics teaching and mathematics learning, and reported changes in teaching practices. Outcomes of the programme included a reduction in out-of-field teaching of mathematics and increased opportunities for graduates to teach higher level mathematics in the senior post-primary years. These teachers also endorsed child-centred beliefs and reported teaching practices consistent with the problem-solving orientation of the new mathematics curriculum. The findings go some way towards testing a theory of teacher change in order to enhance our understanding of how professional development works to upskill out-of-field teachers

Restoration of SMN in Schwann cells reverses myelination defects and improves neuromuscular function in spinal muscular atrophy

Spinal muscular atrophy (SMA) is a neuromuscular disease caused by low levels of SMN protein, primarily affecting lower motor neurons. Recent evidence from SMA and related conditions suggests that glial cells can influence disease severity. Here, we investigated the role of glial cells in the peripheral nervous system by creating SMA mice selectively overexpressing SMN in myelinating Schwann cells (Smn(−/−);SMN2(tg/0);SMN1(SC)). Restoration of SMN protein levels restricted solely to Schwann cells reversed myelination defects, significantly improved neuromuscular function and ameliorated neuromuscular junction pathology in SMA mice. However, restoration of SMN in Schwann cells had no impact on motor neuron soma loss from the spinal cord or ongoing systemic and peripheral pathology. This study provides evidence for a defined, intrinsic contribution of glial cells to SMA disease pathogenesis and suggests that therapies designed to include Schwann cells in their target tissues are likely to be required in order to rescue myelination defects and associated disease symptoms

Lymphoid Tissue Inducer Cells: Pivotal Cells in the Evolution of CD4 Immunity and Tolerance?

Phylogeny suggests that the evolution of placentation in mammals was accompanied by substantial changes in the mammalian immune system: in particular lymph nodes and CD4 high affinity memory antibody responses co-evolved during the same period. Lymphoid tissue inducer cells (LTi) are members of an emerging family of innate lymphoid cells (ILCs) that are crucial for lymph node development, but our studies have indicated that they also play a pivotal role in the long-term maintenance of memory CD4 T cells in adult mammals through their expression of the tumor necrosis family members, OX40- and CD30-ligands. Additionally, our studies have shown that these two molecules are also key operators in CD4 effector function, as their absence obviates the need for the FoxP3 dependent regulatory T (Tregs) cells that prevent CD4 driven autoimmune responses. In this perspective article, we summarize findings from our group over the last 10 years, and focus specifically on the role of LTi in thymus. We suggest that like memory CD4 T cells, LTi also play a role in the selection and maintenance of the Tregs that under normal circumstances are absolutely required to regulate CD4 effector cells

Chemical characteristics of macroscopic pyrogenic carbon following millennial-scale environmental exposure

Pyrogenic Carbon (PyC) is ubiquitous in global environments, and is now known to form a significant, and dynamic component of the global carbon cycle, with at least some forms of PyC persisting in their depositional environment for many millennia. Despite this, the factors that determine the turnover of PyC remain poorly understood, as do the physical and chemical changes that this material undergoes when exposed to the environment over tens of thousands of years. Here, we present the results of an investigation to address these knowledge gaps through chemical and physical analysis of a suite of wood PyC samples exposed to the environment for varying time periods, to a maximum of >90,000 years. This includes an assessment of the quantity of resistant carbon, known as Stable Polyaromatic Carbon (SPAC) versus more chemically labile carbon in the samples. We find that, although production temperature is likely to determine the initial ‘degradation potential’ of PyC, an extended exposure to environmental conditions does not necessarily mean that remaining PyC always progresses to a ‘SPAC-dominant’ state. Instead, some ancient PyC can be composed largely of chemical components typically thought of as environmentally labile, and it is likely that the depositional environment drives the trajectory of preservation versus loss of PyC over time. This has important implications for the size of global PyC stocks, which may have been underestimated, and also for the potential loss of previously stored PyC, when its depositional environment alters through environmental or climatic changes

Physical function following TKA compared to age matched healthy controls

Purpose: to explore whether physical and functional impairments exist in those who have undergone primary TKA compared to age matched healthy controls. Relevance: Many studies have suggested that although function generally improves following TKA, patients continue to experience significant functional limitations. Most of these studies however have assessed function using self-reported measures despite recommendations that both self-report and performance based measures are required to capture the full spectrum of functional ability. Furthermore, there have been no recent studies that have comprehensively compared outcomes in TKA with those who have no knee related pathology. Therefore, the evidence to suggest that functional limitations persist cannot be considered as robust. Participants: A group of patients (n = 15) were recruited who had undergone primary TKA for osteoarthritis between 10 and 14 months previously (median age = 71 years). A group of age matched health controls (n = 12, median age = 69.5 years) were recruited from local community groups. Methods: Self reported function (0-100 scale where 0 is best), timed-up-and-go, stair ascent/descent, walking speed, leg extensor power and range of motion were compared between groups. Analysis: Mann-Whitney U-tests were used to detect inter-group differences. The alpha level was set at 0.05. Results: Maximum flexion in the TKA group (median = 110o) was significantly less (p = 0.002) than the control group (median = 120o). The TKA group reported significantly worse function (median scores TKA = 10.0, control = 0.00, p = 0.028). No significant differences (p >0.05) however were found between groups in any of the performance based measures of function (timed up and go, timed stair ascent/descent, walking speed) or in knee extensor strength. Conclusions: although individuals with TKA perceived their functional ability to be significantly worse than their healthy counterparts, there was no evidence to suggest that significant functional impairments existed in this small group. Implications: expectations of outcome in TKA have been shown to be an important factor in overall patient satisfaction with their surgery. The results of this study could help to provide improved information regarding functional ability following TKA.sch_phyunpub2310unpu

Mechanisms of Cell Death in the Transmissible Spongiform Encephalopathies

N/

Coaching Parents of Children with Sensory Integration Difficulties: A Scoping Review

Aim. To review current evidence regarding the effectiveness of occupational therapy coaching interventions for parents of children with sensory integration difficulties, delivered to individuals or groups of parents. Method. A historical scoping review was completed of empirical research records to summarize what is known and how this information can guide future research. The process was guided by PRISMA guidelines. Inclusion criteria were English language and peer-reviewed empirical studies of parent coaching intervention for children with sensory processing or sensory integration difficulties. Five databases were searched. Papers were critically reviewed using McMaster’s guidelines. Results. Four studies met the search criteria. Three studies took a direct coaching approach with individual parents or families. The fourth study took a mixed educational/coaching approach with groups of parents and teachers. Conclusion. There is some evidence to conclude that occupational therapists can deliver individual parent-focused coaching interventions which impact positively on individual child goals, parental stress, and sense of competence. Group intervention can lead to caregivers’ improved perceived and actual knowledge of sensory integration, as well as a sense of self-efficacy in dealing with sensory-related child behaviors. Current evidence is limited. Suggestions for future research are offered